The Association Between Reflective Functioning and Parent–Child Relationship Quality

Research consistently links adult and infant attachment styles, yet the means by which attachment is transmitted is relatively elusive. Recently, attention has been directed to the psychological underpinnings of caregiver sensitivity—originally thought to be the mechanism of transmission—as indicated by caregivers’ ability to keep in mind children’s mental states when interpreting children’s behavior, or reflective functioning. Unfortunately for researchers, extant measures of reflective functioning are time-consuming and require extensive observation and coding. A self-report measure could help facilitate the study and assessment of reflective functioning in research and clinical settings. This study investigated the relationship between parental reflective functioning and multiple aspects of the parent–child relationship, by using a new, self-report measure of reflective functioning. Participants were 79 caregivers (M _age = 31.8 years) who completed self-report measures assessing reflective functioning, parent–child relationship characteristics, perceived rejection in early relationships, attachment anxiety and avoidance in current close relationships, depression, and substance use. The results indicated that reflective functioning is a strong predictor of parent–child relationship quality (i.e., parental involvement, communication, parent satisfaction, limit setting, and parental support), independent of other potential indicators. Findings support parental reflective functioning as a contributor to the quality of parent–child relationship and suggest that a parent’s capacity to reflect on the mental states of his or her child in parent–child interactions may provide a key target for interventions that aim to improve parent–child relationships.     

Child Psychosocial Functioning and Parent Quality of Life Among Clinically Referred Children

We examined factors that account for quality of life among parents of clinically referred children. Families (N = 201) of children (ages 3-14) referred for oppositional, aggressive, and antisocial behavior participated. Parent and family contextual factors and child psychosocial functioning (symptoms and impairment) were predicted to influence parents' quality of life. As predicted, socioeconomic disadvantage, parent stress and psychopathology, poor interpersonal relations, and limited social support were related to lower levels of quality of life. Once these factors were controlled, child psychosocial functioning also contributed positively to quality of life. Further research on quality of life in the family can have important implications for understanding the context of both child and parent functioning.     

Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Every year approximately 130 families participate in Intercept, a program for struggling teens and their families at the Voyageur Outward Bound School, because they are concerned about the loss of trust, poor communication, and/or other high-risk behaviors they are experiencing with their children. Though families hope for improvements in family functioning, little research has been done on the impact of this type of program on the parent/child relationship or how families function once they leave the program. This phenomenological study collected qualitative data from nine families to determine what positive relationship outcomes emerged between parent(s) and their adolescent child post-program, as well as what aspects of the program curriculum were helpful in improving the parent/child relationship. Results showed that communication among family members improved as a result of participation in the Outward Bound program, and families reported utilizing new skills they had learned, including the use of time-outs, improved listening, and other assertive communication tools. Families reported that the parent/child conference at the end of the program was the most helpful aspect of the Intercept curriculum for improving the parent/child relationship. Implications for family therapy include support for therapeutic wilderness programs as a viable intervention for families of high-risk teens struggling with communication.     

Between pink and blue: a multi-dimensional family approach to gender nonconforming children and their families

Families of gender nonconforming children need to negotiate the interactions between two gender systems: a rigid gender binary imported from familial, social, and cultural experiences and a fluid gender spectrum articulated by their child. This article reviews parental reactions to nonconforming gender developments and poses that the parental mandates of protection and acceptance are problematized by the difference of gender norms between the child and the family, as well as the child and the environment. Through multiple therapeutic modalities-parental coaching and education, parent support group, and child and family therapy-the author illustrates interventions supporting both parents and prepubescent children in their negotiation of safety, connection, and fluidity. Case vignettes illustrate the method in action.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Looking for Solutions: Gender Differences in Relationship and Parenting Challenges Among Low‐Income,Young Parents

The need for parenting and relationship strengthening programs is important among low‐income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio‐recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co‐parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes.     

The Influence of Mothers' and Fathers' Parenting Stress and Depressive Symptoms on Own and Partner's Parent‐Child Communication

This study examines how parenting stress and depressive symptoms experienced by mothers and fathers influence their own (actor effects) and the partner's (partner effects) parent–child communication. Based on the Actor‐Partner Interdependence Model, data from 196 families were analyzed, with both parents rating their parenting stress and depressive feelings, and parents as well as children rating the open parent–child communication. Actor effects were found between parenting stress and open parent–child communication, whereas partner effects were prominent between depressive symptoms and open parent–child communication. The results provide no evidence for gender differences in the strength of the pathways to open parent–child communication. Our findings demonstrate the need to include both parents in studies on parent–child communication to enhance our understanding of the mutual influence among family members.     

Eavesdropping on Health: A Naturalistic Observation Approach for Social Health Research

This article provides an overview of a novel ecological momentary assessment method called the electronically activated recorder or EAR. The EAR is a portable audio recorder that periodically records snippets of ambient sounds from participants' momentary environments. In tracking moment-to-moment ambient sounds, the EAR yields an acoustic log of a person's day as it naturally unfolds. As a naturalistic observation method, it provides an observer's account of daily life and is optimized for the assessment of audible aspects of participants' daily social environments and interactions. The article discusses the EAR method conceptually and methodologically and identifies three important ways in which it can enrich social health research. Specifically, it can help cross-validate research findings independent of self-reports, calibrate psychological measures against behavioral markers of real-world social functioning, and further our understanding of the role that people's mundane social interactions and language use play in coping and health.     

A community led approach to delivery of the Parents Plus Children's Programme for the parents of children aged 6–11

Childhood internalising and externalising disorders tend to persist when left untreated and place affected individuals at higher risk of compromised outcomes. The social costs include school dropout, unemployment, family breakdown and substance abuse. Effective preventive interventions require a public health approach. The aim of this experimental study was to evaluate the effectiveness of the Parents Plus Children's Programme (PPCP) delivered in community and school contexts by frontline professionals from diverse backgrounds. Participating parents with children aged 6 to 11 were randomly assigned to a Treatment Group (n = 44) or a no treatment Control Group (n = 31). The efficacy of training was assessed using self-report questionnaires completed by participants in both Treatment and Control groups. Significant post treatment improvements were recorded on measures of parenting-related stress, child problem behaviour and parent satisfaction with medium to large effect sizes. Treatment group results were maintained at six-month follow-up. These results support the efficacy of the PPCP as a community led intervention with potential to prevent and interrupt child behaviour problems through supported parenting practice, before problems become critical and entrenched.     

Family functioning and involvement in home visiting: Examining program characteristics as moderators to support retention in services

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent–child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent–child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent–child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent–child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent–child relationships.     

Child characteristics,family demographics and family processes: Their effects on the stress experienced by families of children with disabilities

Parents of children with disabilities are often reported as having more stress than their counterparts. Because past investigations of parent stress have been limited by considering too few sources of stress, this study gathered a large variety of demographic, child and family process variables. Two domains of parenting stress, including those aspects related to the child's characteristics (child related) and those aspects concerned with the parent's attitudes toward parenting (parent related) were analyzed separately. The results showed that the circumstances and processes of a family, as well as child characteristics, must be taken into account when clinicians attempt to mediate problems. This research has direct application for clinicians and interventionists. If intervention hopes to truly serve families, a thorough understanding of parenting stress is needed.     

Family wealth and parent–child relationships

This study examined associations between self-reported family wealth and parent–child relationships, by contrasting three theoretical perspectives on the shape of the association. The study utilized data from the Norwegian part of the “Health behaviour in school-aged children study (HBSC) 2013/2014”, with a sample of 3383 children aged 11–15 years old. The shape of associations between family wealth and parent–child communication were tested using regression spline models with knots at 1 SD below mean family wealth and at 1 SD above mean family wealth. The regression spline models showed that increasing family wealth was associated with easier family communication, clearer family communication, and higher family support. Results revealed that for boys, the association between family wealth and outcomes was stronger for the lower segment of family wealth, than in medium and high segments of family wealth. For girls, the gradient across level of wealth was monotone, with higher parent–child communication and higher family support at higher family wealth. To conclude, the results from this study suggest a nonlinear pattern of inequality in parent–child relationships across the range of family wealth.     

Self-efficacy,parent–child relationships,and academic performance: a comparison of European American and Asian American college students

Parent–child relationships play an important role in successful academic outcomes. Previous research suggests that the association between parent–child relationships and offspring’s academic achievement may be mediated by offspring’s self-efficacy levels, although these relationships are not fully understood. Furthermore, the association between family support and academic outcomes is well-documented among European Americans, but not across cultures. Therefore, the present study examined how parent–child relationship quality relates to young adults’ academic achievement and self-efficacy among European Americans and Asian Americans. Participants were 258 undergraduate students (85 male, 173 female) who completed a survey. Overall, both parent–child relationships and self-efficacy were significantly associated with the offspring’s academic performance, and self-efficacy mediated the relationship between parent–child relationships and school outcomes. Ethnicity moderated these relationships: among European American students, quality of parent–child relationships was not associated with self-efficacy level whereas for Asian Americans, parent–child relationships were associated with self-efficacy. These findings suggest that European American college students’ self-efficacy levels are less dependent on parent–child relationship quality, but for Asian Americans college students it may be important for educators to facilitate communication and family support so students may continue to use family as a resource for self-efficacy levels.     

Family Interactions in Children With and Without ADHD

We used global ratings to compare the family (parent[s]-child) interactions of 51 clinic-referred children with ADHD and 32 non problem children. Children and parent(s) were videotaped while engaging in problem solving and game playing activities. Independent coders, blind to children's diagnostic status, rated the interactions using measures designed to assess interaction competence and quality. Significant group differences emerged between the ADHD and control groups during problem solving on the interaction quality measures of Warmth, Engagement and Communication. Comparisons of the interactions of families of children with ADHD, with (ADHD W) and without (ADHD W/O) comorbid disruptive behavior disorders, were non significant, although increased symptomology was associated with reduced Warmth and Engagement during problem solving. Irrespective of group membership family interactions were more positive during game playing versus problem solving.     

Family involvement for children with disruptive behaviors: The role of parenting stress and motivational beliefs

Children with disruptive behaviors are at risk for adverse outcomes. Family involvement is a significant predictor of positive child behavior outcomes; however, little research has investigated parent psychological variables that influence family involvement for children with disruptive behaviors. This study investigated the role of parental motivational beliefs (i.e., role construction and efficacy) as a potential mechanism by which parenting stress impacts family involvement for families of children with disruptive behaviors. Results indicated that parent role construction mediated the relation between parenting stress and all aspects of family involvement examined (i.e., home-based involvement, school-based involvement, and home-school communication). Parent efficacy mediated the relation between parenting stress and home-based involvement only. Parents of children with disruptive behaviors reporting stress may experience negative beliefs about their role and efficacy to support their child's education, which may thereby negatively influence their actual involvement. Therefore, parent motivational beliefs may serve as an important point for intervention to support involvement of families of children with disruptive behavior.     

Family functioning within the context of families with adolescent children in urban India

Research on family functioning within given cultural contexts is needed. This study aims to describe salient dimensions of family functioning in two urban contexts in India and to examine differences in family functioning by sociodemographic groups. We measured differences in family functioning using cross-sectional survey questionnaire data collected from 13 to 15-year-old adolescents and one of their parents/primary caregivers in Mumbai (n = 843) and Kolkata (n = 913) during 2019–2020. We drew a multi-stage sample representative of neighborhoods and households in both cities. We assessed a multi-dimensional family functioning latent factor that included parent-reported measures (parent–adolescent communication, family cohesion, and parent monitoring of peers) and adolescent-reported measures (parent support, family cohesion, and parent supervision). Our results support an overall measure of family functioning manifested by multiple dimensions for parent- and adolescent-reported data. Families with male adolescents had worse adolescent-reported family functioning in Mumbai and parent-reported family functioning in Kolkata. Higher socioeconomic status was associated with better parent-reported family functioning in both cities and better adolescent-reported family functioning in Kolkata. Muslim religious identification in Kolkata and the Hindi native language in both cities were associated with better adolescent-reported family functioning. Our findings indicate heterogeneity in family functioning across demographic and social-cultural groups within the two urban contexts of India. This study may inform the development of culturally congruent prevention interventions for families with adolescents in India.     

Family Processes and Mental Health among Children and Caregivers in a Family Strengthening Program

Oppositional defiant disorder (ODD) is a common mental health concern and is particularly prevalent among children living in poverty-impacted communities. A family strengthening/parent management training (PMT)-based multiple family group (MFG) program entitled, the 4 Rs and 2 Ss for Strengthening Families, focuses on the following family process variables: rules, responsibilities, relationships, respectful communication, social support, and stress. While evidence supports effectiveness of this treatment program, less is known about the specific relationship between the family process variables and mental health outcomes of children and caregivers. The current study examined these relationships among a sample of 287 caregiver/child dyads who participated in a NIMH-funded Type II hybrid effectiveness-implementation study in New York City. Data were analyzed using SPSS 27 and Mplus 8. Results indicated that two of the six family process variables related to one or more child and caregiver mental health outcome. Caregiver stress significantly related to child inattention (b?=?0.034, SE?=?0.01, p?<?0.001), child ODD (b?=?0.053, SE?=?0.02, p?<?0.01), and caregiver depression (b?=?0.049, SE?=?0.02, p?<?0.01). Family rules significantly related to caregiver depression (b?=?0.228, SE?=?0.11, p?<?0.05) over time. Findings point towards the substantial role of caregiver stress in child and caregiver mental health, in addition to the impact of inconsistent discipline with difficulty establishing rules on caregiver depression. Examinations of treatment components in relation to improvements in child and caregiver mental health can guide practitioners towards utilizing models that result in positive therapeutic outcomes and/or making adaptations with added content that has been shown to be effective.

     

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.     

Exploring Correlates and Predictors of Stress in Parents of Children Who are Deaf: Implications of Perceived Social Support and Mode of Communication

Parenting stress has been linked to negative outcomes for both parents and children, including poor attachment, behavior problems, less positive parent–child interactions, and marital dissatisfaction. Given that parents of special needs children often experience excess stress, they may be susceptible to negative outcomes, thus investigations of protective factors are needed. We explored relationships among parenting stress, social support, mode of communication, and child cochlear implant status in parents rearing a deaf child or child with hearing loss. Findings of our exploratory study indicated that parents of children who use sign language only reported more support, while parents of children who use total communication exhibited less self-reported stress. Also, parents with children who use implants did not differ on any of the measures compared to parents of children without implants. Additional findings suggested that higher levels of perceived social support corresponded with lower stress among parents, however, receipt of supportive behaviors did not correlate significantly with parenting stress. In an overall model, perceived social support and mode of communication were significant predictors of parenting stress. Finally, enacted support predicted significantly life satisfaction in parents. Implications and limitations, as well as suggestions for future research, will also be offered.